What can be learned from natural disasters, from the healthcare IT standpoint? As it turns out, a lot can. At a session held on Wednesday during HIMSS18, held this week at the Sands Convention Center in Las Vegas, healthcare IT leaders from different communities shared their perspectives on some of what happened during and after Hurricanes Irma, Maria, and Harvey last year.
As the session description of Session 64, “Learning from the Devastating Effects of Three Hurricanes: The Critical Role of Health IT,” summarized it, “During the 2017 hurricane season, Mother Nature launched an all-out assault on portions of Texas, Florida, Puerto Rico and the Virgin Islands. With harsh winds, heavy rain resulting in historic flooding, and the aftermath that affected every aspect of human existence, there are lessons for all to learn regardless of the type of natural disaster. From a health IT perspective, many prepare for a potential disaster across infrastructure, communications, and alternatives to patient care delivery that organizations hope never occur. However, in the case of Hurricanes Harvey, Irma, and Maria, it affected every aspect of healthcare operations.”
José L. Abrams Guzmán, CIO and CTO at Servicios de Salud Episcopales, a health system based in Ponce, and anchored by Hospital San Lucas Ponce, a 161-bed community hospital, shared with the audience the devastating experience of Hurricane Maria, which hit Puerto Rico in September, just days after Hurricane Irma had hit the island. “We have 3.4 million people in Puerto Rico,” he noted. “Being an island presents a lot of challenges, because of the distance, and also around health services.”
What’s more, Abrams Guzmán noted, “We had activated our contingency plans” when Maria hit. “The problem is that we probably think that the worst that is going to happen is being cut off for a two-week period”; and in fact, as everyone now knows, the effects of Hurricane Maria have lasted even through the present. Among the issues related to that: “an old and susceptible power infrastructure with a median age of power plants equal to 44 years. Still recovering from Irma, two weeks earlier, about 80,000 people remained without power while Maria approached,” Abrams Guzmán noted. “Yes, 450 shelters opened on the afternoon of September 8,” he recounted. “By September 19, at least 2,000 people in Puerto Rico had sought refuge.”
Among the key operational challenges: “There was no information during or immediately after the emergency, and only one AM radio station was on the air. No communication between and among clinicians, administration personnel, service providers, suppliers, police stations, and emergency responders, was possible.” Meanwhile, “Airports and marine ports were paralyzed. And, as healthcare services, we weren’t the priority for emergency responders.” What’s more, he noted, “Everything had to be paid for in cash.”
What was learned from the experience of Hurricane Maria? In fact, Abrams Guzmán told the audience, “We learned a lot of things. First, we need to be prepared for a completely isolated situation, and consider the worst-case scenario, that of a power and communications loss of 100 percent.” Prior to Maria, he said, “we had usually prepared to manage a two-week period of an emergency.” That no longer appears realistic going into the future.
What’s more, Abrams Guzmán said, “During the recovery process, both electricity and communications may fail intermittently. Indeed,” he said, “we’re still having problems with power and communications.” What’s more, “After the emergency, we need the ability to install an alternate regional communications system. If you don’t have communications to transfer patients from one location to another, how can you manage that?”
Among the actions that should be considered in the future, Abrams Guzmán said, are these: “A regional repository of patient data should be considered for cases where access to the EHR [electronic health record] is lost. What about all the data?” Also, “We have processes to manage the situation on paper, but what about the data of the patient? We should establish regional centers to maintain data.” In addition, he said, “We need to maintain good relationships with service providers, which is the only way to ensure you’re one of their priorities.” Further, he said, “You need 3X redundancy in power. We had 3X redundancy in power at our hospital, which is better than 2X. That’s better both in power generators and communications.”
In addition, he said, “During emergencies, improvisation is allowed. Technology allows us to redesign during the recovery process.” And, he said, “the choice of cloud versus onsite data centers, must be evaluated.”
Kendall Brown, a member of the board of South Florida HIMSS, spoke about the impact of Irma. “To begin with,” said Brown, an enterprise sales executive at Allscripts, “6.3 million Floridians were advised to evacuate; I was one of them. Getting out wasn’t an issue, but getting back in was.” Further, she noted, “Nearly 12 percent of the states’ more than 300 hospitals closed, primarily as precautionary measures.”
Among the many challenges of Irma in Florida: “A diversity of residents, and multi-language barriers involving the use of technology applications. Also,” she said, “we have residents from various countries; and not everyone has a signal or Internet access.”
Also, Brown noted, “Some residents were trapped in areas with no access to electricity, which means no power, no Internet, and no access to electronic health records.” In addition, she noted, “Some areas lost power for one to three weeks. And of course, loss of power limits the use of health IT.”
Other issues particular to Florida: “We faced a water issue with storm surge. Storm surge impacts the ability to provide healthcare services, as some highways and other roadways, and other areas were flooded. We also had issues around excessive wind. And the combination of wind and water was particularly challenging, given that overland wiring is still prevalent in Florida. Wind damage particularly impacted overland lines, resulting in extensive power outages for extensive periods of time, while there was water damage to more isolated areas.”
All of these types of damage made things difficult, in that, as Brown put it, “People’s expectations are that technology is ‘always on’—and those expectations have increased,” in the present day.
One thing that helped a great deal, Brown said, was “non-traditional interoperability, like telemedicine. Several vendors made telemedicine services available at no cost.” Her own company, Allscripts/Surescripts, provided 12 months of medication history, via a cloud-based smartphone app.
In the future, Brown said, healthcare IT leaders should carefully consider blockchain when planning for natural disasters. “They should explore how to create a minimal shared view of data that is viewable by all providers, payers, and responders. And they should use the cloud in order to not rely on data that has been stored in a potentially compromised hospital location.”
Analyzing Harvey’s impact, suggesting preparations for the future
Jim Langabeer, a professor of health informatics and management at the University of Texas Health Science Center at Houston, shared with the audience that he is currently doing research on disasters and emergencies, and on “how we can do better.”
With regard to Hurricane Harvey, which devastated southeast Texas last August, Langabeer noted, “Harvey brought over five feet of rain to Houston and southeast Texas in less than two days. We had over $125 billion in storm damages, and more than 40,000 people were displaced, while nearly 350,000 area residents lost power. Dozens of hospitals were forced to evacuate, while our largest county hospital saw its EMS bays and first floor totally flooded, resulting in the needed diversion of patients from that hospital to others.” In addition, he noted, “The area’s two largest sports arenas became shelters” for residents displaced by the storm.
Among the recommendations he is studying for the future: community-wide data coordination plans; integrated, patient-level dashboards in shelters; regional health information exchange; better patient-level analytics, available at the point of care during disasters; improved patient communications and portals; and a coordinated social media strategy.